Provider Demographics
NPI:1639136674
Name:DRUM-LAL, PATRICIA ANN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:DRUM-LAL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:TRICIA
Other - Middle Name:ANN
Other - Last Name:DRUM-LAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:9322 CATTARAUGUS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2339
Mailing Address - Country:US
Mailing Address - Phone:310-838-8174
Mailing Address - Fax:
Practice Address - Street 1:1328 22ND STREET
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2091
Practice Address - Country:US
Practice Address - Phone:310-582-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15535207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA15535Medicaid
CAPA15535Medicaid
PA9755Medicare UPIN